N.Y. Comp. Codes R. & Regs. tit. 14 § 671.5

Current through Register Vol. 46, No. 45, November 2, 2024

Section 671.5 - Allowable services

(a)Principles of compliance.

(1) Allowable community residential habilitation services by an authorized provider (see glossary) are those appropriately supervised (see glossary) activities, interventions and therapies necessary for the maximum reduction of functional and/or behavioral deficits associated with the person's developmental disability.

(2) Services shall be designed and implemented to train, or develop skills, capabilities or knowledge appropriate to enhance or improve a person's independence, lessen dependence or minimize loss of functioning or adaptive capacity.

(3) The expressed treatment goal of community residential habilitation services shall be to promote and encourage outcomes related to independence, integration, individualization, and productivity.

(4) Categories of allowable services.

(i) Health skills training services. Activities, interventions and therapies designed to promote independence in personal health care by increasing the person's awareness of his or her physical health status and the resources required to maintain physical health, including, but not limited to, regular medical and dental appointments, basic first aid skills and basic knowledge of proper nutritional habits. Also included is training on topics such as disease prevention.

(ii) Self-administration of medication training services. Activities, interventions and/or therapies designed to develop skills and enhance capacity (or limit regression) in the functional areas including, but not limited to, understanding the role and effect of medication, the importance of adherence to any medication regimen, and the performance of the actual behavior(s) necessary to actually take medication in accordance with a prescribed regimen. While not including the act of prescribing, such training does include activities related to reviewing the need for, and appropriateness of the person's medication regimen with his/her physician or health care provider.

(iii) Socialization skills training services. Activities, interventions and therapies which are designed to assist the person in developing skills and enhancing capacities that diminish tendencies toward isolation and withdrawal by assisting the person in the acquisition or development of social and interpersonal skills. "Socialization" is an activity meant to improve or maintain a person's capacity for social involvement by providing opportunities for the application of social skills. This occurs through resident and staff interaction in the program and through exposure with staff to opportunities in the community. Modalities used in socialization include individual and group counseling and behavior intervention.

(iv) Communication skills training services. Activities, interventions and therapies designed to develop skills or enhance capacity (or limit regression) in the functional areas including; but not limited to expressive language; receptive language; use of adaptive/specialized communication devices; and listening skills.

(v) Functional skills training services. Activities, interventions and therapies which are designed to develop skills and enhance capacities (or limit regression) to engage in the primary activities of daily life. Services are provided by addressing areas of functioning such as: dressing, personal hygiene and grooming, selection and/or preparation of food, cleaning and washing of clothes, maintenance of the personal environment, budgeting and money management, education in general health, family planning and use of community resources such as public transportation. Training is intended to increase those competencies needed by the individual to live in his or her chosen environment.

(vi) Assertiveness/self-advocacy skills training services. Activities, interventions, and therapies which promote the person's ability to assess and utilize his or her strengths and capacity to make life status changes and to increase self-awareness about his or her values and preferences. Training also focuses on increasing a person's ability to respond to medical, safety and other personal problems. Activities are also intended to improve communication skills and facilitate appropriate interpersonal behavior.

(vii) Behavior skills training services. Activities, interventions and therapies designed to develop skills and enhance capacities (or limit regression) in the functional areas including; but not limited to, interpersonal behavior; minimizing/eliminating self-injurious behavior; minimizing/eliminating aggressive behavior; and conducting oneself appropriately in various community settings.

(viii) Community integration and resource utilization skills training services. Activities, interventions and therapies which are designed to help the person identify skills and community supports necessary for specific environments, to assess their skills and strengths in relationship to meeting environmental demands, to access resources available to help the person, and to develop a natural support system by assessing social, educational and recreational opportunities and learning how to make choices.

(ix) Motor skills training services. Activities, interventions and therapies designed to develop a person's skills or enhance capacity (or limit regression) in the functional areas including, but not limited to, mobility in walking/sitting/standing; fine and gross motor activities; and use of adaptive mobility equipment.

(x) Skills development training services. Activities, interventions and therapies which enhance utilization of the skills necessary to undertake employment or pursue education opportunities. This may include developing and enhancing skills related to securing appropriate clothing, scheduling, work-related symptom management, and work readiness training.

(5) Community residential habilitation services. Effective July 1, 1996, the provider of community residential habilitation services in a supervised community residence, shall be responsible for any necessary transportation to and from physician, dentist, and other clinical services, and any other transportation appropriate to the person's participation in community-based out-of-residence activities planned for or sponsored by the residence. Nothing herein shall be interpreted as precluding the accessing of separate Medicaid claiming for emergency/nonemergency ambulance services (as defined in 18 NYCRR 505.10) necessitated by the person's medical condition.

(6) The provider of community residential habilitation services in a supervised community residence is responsible for the cost of:

(i) services that are necessary to meet the needs of individuals while in residence;

(ii) services that, prior to August 1, 2004, could have been met by home health aide or personal care services separately billed to Medicaid;

(iii) services that, prior to October 1, 2015, could have been met by home health aide or personal care services separately billed to Medicaid, with those services provided in the community on weekday evenings or anytime on the weekend, unless the weekday evening or weekend services are established to support the individual in an integrated job site; and

(iv) services specified in paragraph (7) of this subdivision that, prior to October 1, 2015, may have been separately billed to Medicaid.

(7) Effective October 1, 2015, residential habilitation services in a supervised CR include the following clinical services delivered to an individual that are directly related to the individual's residential habilitation plan:

(i) nutrition services that consist of meal planning and monitoring, assessment of dietary needs and weight changes, development of specialized diets, diet education, and food safety and sanitation training;

(ii) behavioral intervention and support services delivered by a licensed psychologist, licensed clinical social worker, or behavioral intervention specialist that consist of behavioral assessment and intervention planning, delivery and review or monitoring of behavioral interventions, and behavioral support services provided pursuant to section 633.16 of this Title; and

(iii) nursing services that consist of:

(a) training and supervision of direct support staff who perform health-related and delegated nursing tasks that include, but are not limited to, observation for illness and injury, medication administration, tube feeding, and colostomy care;

(b) development and monitoring of written plans of nursing services that identify interventions direct support staff carry out to address individuals' health care needs;

(c) availability of nursing supervision, by a registered nurse, on site or by telephone, at all times to respond to direct support staff in order to address individuals' ongoing and immediate health care needs;

(d) coordination of individuals' health care services, including, but not limited to, arranging for needed medical appointments and diagnostic testing, interfacing on behalf of individuals with community-based healthcare providers, and ensuring that treatments are carried out in accordance with physicians' orders; and

(e) provision of direct nursing care that cannot be delegated to direct support staff and that is available within the staffing plan at the residence and/or is not available through other sources.

(8) The provider of community residential habilitation services in a supportive CR is responsible for the cost of services that, prior to October 1, 2015, could have been met by a home health aide or personal care services separately billed to Medicaid; either

(i) at the residence at any time; or

(ii) in the community on weekday evenings or anytime on the weekend, unless the weekday evening or weekend services are established to support the individual in an integrated job site.

(b)Standards of certification.

(1) OPWDD shall verify that the facility is claiming for the provision of services consistent with the contents of the persons' plan(s) of services.

(2) OPWDD shall verify that staff members are appropriately trained and supervised to deliver the services for which they are responsible.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 671.5

Amended New York State Register October 28, 2015/Volume XXXVII, Issue 43, eff.11/1/2015

Amended New York State Register March 30, 2016/Volume XXXVIII, Issue 13, eff.4/1/2016

Amended New York State Register April 20, 2016/Volume XXXVIII, Issue 16, eff.4/20/2016

Amended New York State Register September 21, 2016/Volume XXXVIII, Issue 38, eff. 9/21/2016

Amended New York State Register November 15, 2017 /Volume XXXIX, Issue 46, eff.11/15/2017